Provider Demographics
NPI:1073609368
Name:NORTHEAST DUPAGE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTHEAST DUPAGE SURGERY CENTER, LLC
Other - Org Name:SUBURBAN SURGERY CENTER OF DUPAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FATO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CASC
Authorized Official - Phone:630-505-3383
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 3279
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1001
Mailing Address - Country:US
Mailing Address - Phone:630-285-7000
Mailing Address - Fax:630-799-0223
Practice Address - Street 1:1580 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1171
Practice Address - Country:US
Practice Address - Phone:630-285-7000
Practice Address - Fax:630-799-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002496261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7002496OtherSTATE LICENSE
IL7002496OtherSTATE LICENSE
IL7002496OtherSTATE LICENSE